Friday, November 04, 2011

Where To Find the Real Corruption

Well, well, well… decided (late last night, at 10:30 pm) to publish an article following up on the Times-Picayune’s indictment last year about Dr. Jullette Saussy’s supposed wrongdoing and corruption by holding a second job with the Vidacare Corporation while working full-time as the director of EMS for the city of New Orleans. The follow-up article covers the state ethics board’s decision that Dr. Saussy was cleared of any wrongdoing by holding the second job.

In the article, Vidacare’s relationship with the city is described. It details that their products are purchased “through a third-party company that distributes them” and that the city has “no direct business relationship with Vidacare.” Therefore, the ethics board cleared Dr. Saussy of wrongdoing on her part. This decision comes thirteen months after Dr. Saussy was asked to resign by the Landrieu administration.

All this talk about ethics gets one to wondering about some things. Obviously, Mayor Landrieu did not wait for a decision by the ethics board before requiring her resignation. WWL television in New Orleans covered Dr. Saussy’s clearance five days prior to the Times-Picayune’s article and put it on prime-time news instead of burying it deep in the archives of their website. So, speaking of ethics, I’d like to submit the question of the ethics of both Mayor Landrieu and the Times-Picayune.

Mayor Landrieu had at his perusal the documents and testimony by Dr. Saussy and City Hall’s legal department of her official permission to work for Vidacare. Granted, all this documentation occurred before his shift at the helm, during the Nagin administration. But so did Dr. Saussy’s employment with Vidacare. By the time Landrieu took office in 2010, Dr. Saussy had been gone from Vidacare for nearly two years. The whole thing should have been a non-issue - a thing of the past. Dr. Saussy was serving the city admirably, and in fact had been doing so even while she worked for Vidacare and fought cancer at the same time. Mayor Landrieu even thought her service was excellent enough to retain Dr. Saussy as head of EMS when he took office.

So what happened? Did some terrible secret come to light? Was there some awful scandal involving Dr. Saussy that screamed for her banishment from public service? Well, no. There wasn’t. There was a story in the newspaper that said Dr. Saussy worked for Vidacare in addition to her primary employment with the city. But wait, didn’t we all know that already? We sure did. Was it a violation of ethics? Basically Landrieu said, “I don’t know; maybe we should ask the state ethics board.” Which Dr. Saussy did. But instead of waiting for their opinion, Mayor Landrieu took as gospel truth the hearsay and imprecise accusations that the Times-Picayune and its commenters had to opine about. Apparently taking into consideration only the dubious journalism of the Times-Picayune and commenters, and not the opinion of any professionals actually versed in medical ethics, he asked for her resignation long before the state ethics board had anything to say on the matter. How much expertise does Mayor Landrieu have on the subject of medical ethics? Well, none, clearly, since those who do said there was no wrongdoing. But that didn’t stop him from firing one of the most valuable assets the city had.

So why is no one calling into question the ethics of Mitch Landrieu? As it turns out, Dr. Saussy was fired for… nothing, really. As someone who assumed a position in which moral integrity is so badly needed, it is deplorable that no one has called into question Mayor Landrieu’s ethics for kowtowing to what could at best be described as yellow journalism instead of getting the facts straight before making such a crucial decision on city leadership. Of note also is the quote in the article by Landrieu’s spokesperson, Ryan Berni, in which he says “we are extraordinarily pleased by Dr. Jeff Elder’s leadership of the department since he became EMS director.” Wow! Way to avoid the question, Berni (and Landrieu)! Spoken like a true politician. And I don’t mean that in a good way.

…Which brings me to the Times-Picayune itself. Last year, the newspaper bent over backwards to accuse Dr. Saussy of wrongdoing when there was none. All the supposed infractions they "uncovered" were already a matter of public record. Dr. Saussy’s employment was approved by City Hall. Donations of sick time to her by fellow employees while she fought cancer was according to established city policies. At no time was she unavailable for her duties as EMS director, despite what the Metropolitan Crime Commission alleges. As I said last year when I wrote about Dr. Saussy’s resignation, the Times-Picayune created a scandal where none existed. This is borne out even further by the decision by the state ethics board that there was no wrongdoing by Dr. Saussy. Yet during that time last year, the newspaper was all atwitter over their latest attempt to bring someone down. It published articles such as “New Orleans’ EMS Director’s Second Job Raises Questions at City Hall” and “New Orleans’ EMS Director Was Given $53,000 In Sick Leave By Paramedics” and “The Moonlighting by New Orleans EMS Director Doesn’t Feel Right: An Editorial.”

I beg your pardon? It doesn’t feel right? Instead of reporting some vague, unquantifiable feeling as the way everyone else should also feel, perhaps as journalists you might stick to objective facts rather than whatever emotional upheaval crosses your fancy at the time.

Here’s a title the Times-Picayune should write an article for: “Times-Picayune Makes False Accusations Of Wrongdoing By EMS Director.” Or perhaps this one: “Times-Picayune Remains Unapologetic For Intentional Libel.” Yes, you bastion of journalistic integrity, I said it: Libel. As alleged journalists, I would expect you know the meaning of the word, but judging by your past attempts at reporting perhaps you should allow me to refresh your memory. Libel: noun. a: Defamation by written or printed words, pictures, or in any form other than by spoken words or gestures. b: The act or crime of publishing it. c: A formal written declaration or statement, as one containing the allegations of a plaintiff or the grounds of a charge. The stories by the Times-Picayune certainly all fit the bill for libel. They falsely defamed Jullette Saussy in print, published it, and insinuated corruption on her part, as did the commenters on who called for her head on a platter.

So tell us, Times-Picayune, what were your motives in reporting this non-story about Dr. Saussy? It doesn’t seem to be uncovering corruption, since those with far greater knowledge of ethics than you about such issues have cleared Dr. Saussy of wrongdoing. Was it about a problem with the city's policy of sick time donation? It doesn’t seem so, since the policy is still in place and you haven’t said a word about it since. Perhaps you were trying to garner sympathy for the anonymous “demoralized” EMT’s and paramedics who were so upset over Dr. Saussy’s absence while she received cancer treatments? No follow-up stories on that either, huh?

Well, then one can only observe that either someone(s) at the the Times-Picayune had a personal vendetta to execute against Dr. Saussy and abused the newspaper and web media to carry it out, or that the staff of the Times-Picayune were caught up in a frenzy of bringing down public officials and pointed their inky cannon at Dr. Saussy and fired away with no regard to facts, other than to put their own peculiar slant on them. Go on, click the links to the articles above. Other than a few repeated quotes by Dr. Saussy, the majority of the articles join together the otherwise unrelated topics of her salary, her employment with Vidacare and the donations of sick time, so that it appears that there was some malicious scheme afoot. There wasn’t. But in their most recent article, instead of apologizing outright for this defamation of character or even seeming sort of apologetic, the Times-Picayune lumps together the now-exonerated Saussy with the likes of those with legitimate, concrete evidence of corruption, such as Joia Crear-Perry (public health director with a suspended license), Kenneth Ferdinand (public credit card used for personal expenses) and Greg St. Etienne (diverting federal grant money intended for non-profits to his brother’s company).

Ethics? Really? Mitch Landrieu has revealed that ethics and facts have nothing to do with his decisions as mayor by dismissing Dr. Saussy based on nothing but false accusations by the TP (abbreviation intentional). The Times-Picayune, in their clearly desperate attempt to legitimize themselves as paragons of journalistic virtue in our corrupt world, has offered no recantation, reparations or even so much as a “woops, our bad” after they single-handedly brought down someone who actually displayed moral integrity and an exemplary ethical paradigm. Jullette Saussy, congratulations on your victory. Mayor Landrieu and the Times-Picayune, you’ve shown us where to look for the real corruption.

Saturday, April 16, 2011

20-A at West End & Harrison (Plane Crash)

Despite the reporter guy's enthusiasm trying to make a Hindenburg-esque "Oh the humanity!" moment out of this, the resounding phrase is "We're fine."
"A plane hit my car."

Wednesday, March 02, 2011

...It’s Carnival Time And Everybody’s Drinking Wine!

...It’s Carnival Time And Everybody’s Drinking Wine!

We find ourselves once again in that special time unique to our city, our much-loved and much-hated Mardi Gras season. There is much to hate about Carnival - the hundreds of thousands of tourists who all come from dry counties and immediately proceed to down “only” five or six Hurricanes or Hand Grenades; the ubiquitous smell; the “can you tell me where such-and-such is?” (two blocks, make a right); the overloaded emergency rooms, the ungodly traffic. There is also much to love about Carnival - EMS gets the absolute best spots on the parade routes (especially if you can back your truck right up to the route), being pelted with throws, Polish sausage & pizza, parade-goers offering you food from their grills, the big parties after the season is done, and of course, the “entertainment” that comes with French Quarter details. One of my favorite feelings is going 10-8 early Mardi Gras day and driving down St. Charles while everyone is setting up for parades; there’s hardly any other traffic and everyone is in a great mood. Good or bad, it’s uniquely New Orleans and the challenges it poses to EMS (and all the emergency services) make it a source of pride when we’ve handled it bravely every year. 

If you’re new to NOEMS, or if you’re a veteran, here’s a few pointers (and yes, I’ve seen EMTs with years of Carnival experience who still need every one of these tips. So pay attention.):

Number ONE, first and foremost, superseding all other pointers: LISTEN TO YOUR RADIO! If you’re unfamiliar with directions in the city, let your more experienced partner listen to the SPEC channel and NOPD. There is nothing worse than being one block from an emergency and not responding because you weren’t listening! 

Know what to say on the radio, especially when communicating with the police. Base 9 (NOPD parade dispatch) doesn’t care or need to know when you’re at the hospital, or that you’re waiting for a bed or whatever. This is what you need to tell them: 1. You’re leaving your assigned location. 2. You’re on scene at a parade item (but not when you get pulled for a regular 911 street call). 3. You’re back at your assigned location. By all means, ask for specifics about a call they sent you to, like if you’re having trouble finding a scene. But do not crowd up the air with “en route to whatever hospital,” or “bathroom break” or “Code 77.” Base 9 doesn’t care and the cops have actual parade-related traffic to air on the SPEC channel. 

Know where your partner is at all times! Since you’re on two different channels, he won’t know if there’s a call on your channel and you won’t know if there’s a call on his channel. Delaying response because you didn’t follow the long-established rules is unprofessional, dangerous and downright wrong. Don’t be that guy.

Do not expect free anything (except parade throws). Expect to pay full price for any snacks or drinks you buy at concession stands, even if you know for a fact that they’re offering free stuff to EMTs. Pull out your wallet to show your good intentions. If you do get anything for free, tip nicely and do not be greedy, going back for more. Otherwise, you’ll ruin it for everybody. Don’t be that guy.

If you’re on the parade route, do not scramble to get parade throws. If you catch something mid-air, great. Otherwise let the tourist or little kid have that cheap Chinese plastic thing.

Act right. Of all times of the year, stressful though it is, be nice. You never know who you’re picking up out of the gutter. I once picked up a very influential travel writer at his worst moment during Carnival. That one story from that one patient can seriously impact our city’s tourist economy for years. Let’s hope it’s a good impact. And if you can’t be nice to the patient (e.g. they’re unconscious or a real asshole), be nice to the friends. When the patient comes around, the friends will tell the patient how great the EMS crew was. Or how awful they were. This goes double, no... triple, for the crew stationed at Gallier Hall. Remember, your bosses (the city council and the mayor) are there watching you. 

Related: Act right. You know perfectly well that someone is drunkenly filming the EMTs picking up the drunk pukey guy in bad drag face down in the gutter on Bourbon Street. That video is gonna be on YouTube, HIPAA be damned. It will go viral and millions of people will see you performing EMT work. Do everything National Registry-style. Swab your IV sites. Don’t walk trauma patients who need a spineboard. Do not let patients turn blue because you didn’t feel like lugging the oxygen around. Do not stop chest compressions till there’s a pulse. I guarantee you there’s someone who will write EMS to complain after seeing that video, and then they’ll put up some huge news story about the poor patient care in NOLA. It would be far better if they wrote in to say what a perfect job was done. 

When responding in elbow-to-elbow crowds, try to get a mounted officer to lead you. People won’t get out of the way for a siren, stretcher, ambulance or ASAP unit, but they will damn sure get out of the way for a horse.

Make sure your boots are snug and protect your ankles. You WILL be walking across seas of grounded beads and you WILL slip. Do not sprain your ankle or break your leg in the process. 

Do not assume that everyone you pick up is drunk, and do not assume that the drunks you do pick up are only drunk. There are some hellacious occult injuries and medical conditions that have been missed because the crews assumed “they’re just drunk.”


Good luck with this year, guys. I miss you! 

Thursday, February 24, 2011

EMS Myth #7: System Status Management lowers response times and enhances patient care

Here's an excellent article about the science (actually, the lack thereof) behind System Status Management:

Feel free to read it while en route to your next posting location (and racking up a whopping 46% increase in ambulance maintenance costs).

Don't kill the messenger.

Tuesday, February 15, 2011

From Both Ends: Food Poisoning In All Its Glory

Lately I’ve seen a few references to “food poisoning.” Most recently is an outbreak in Japan where 840 students were out sick. No doubt that you, dear EMS practitioner, have encountered this same malady, either in your patients or yourself. Perhaps your patient asked you if you thought their symptoms could be food poisoning from that restaurant they patronized. You probably recognized the telltale sign of dollar symbols in their eyes ($_$) as the thought of a lawsuit against the establishment occurred to them. Perhaps your experience came after consuming whatever passed for food at the local convenience store at 3a.m., which had been sitting under the heat lamps since the previous morning (which you consumed on the way to the dollar sign patient). By its very name, it sounds like “someone” poisoned your food. I’ve seen people begin plotting their revenge on this unknown individual, perhaps some busboy or salad chef. Even more hilarious have been the times when the “victim” thought he or she knew exactly who had “poisoned” him, and started to hatch their plan for dark vengeance. 

Food poisoning is not the horrendous plague or crime that is commonly imagined. It occurs when food has been improperly prepared. It’s not caused by someone pouring a foul elixir from a vial marked with a skull & crossbones (that would be actual poisoning; or perhaps voodoo). Food poisoning is caused by bacteria, plain and simple. If you’ve ever had diarrhea, and I know you have, you’ve had some form of food poisoning. 

Very commonly, it’s caused by bacteria that we normally lug around with us every day. The problem comes when it gets somewhere it isn’t supposed to be. For example, escheria coli and staphylococcus aureus (e. coli & staph) are two species living in abundance on your body right now. E. coli lives in colonies weighing kilograms within your lower GI tract. When you poop, about a third of its mass is pure e. coli. Staph lives on every inch of your skin. The problem comes when these little critters set up shop in our upper GI tract, between the mouth and duodenum. It’s not supposed to be there and the anatomical structures in your stomach don’t have the mechanisms to accommodate them, so you get sick. 

Generally food poisoning is facilitated from the way food is prepared. In the case of meat, remember that meat comes from animals that have to be killed and chopped up. It is not grown in those little plastic packages in the supermarket (sorry to shatter your illusion). Animals also have an abundance of bacteria in their GI tract. Food inspectors have to check that the bacteria and germs in the guts don’t contaminate the meat in the slaughtering process. But as you can imagine, when there are a thousand tiny, wooly, innocent lambs cowering in fear or  little calves mooing out of sheer terror as they witnessed their brothers and sisters being disemboweled and dismembered, things can probably get a little hectic as your lamb chops and veal begin their way to your table. With lots of creatures you grew to love in Mother Goose fairy tales dying and being drawn & quartered, it’s reasonable to picture that some of  the bacteria in Little Bo Peep's sheeps' guts might get into the actual chops that make it to the plastic packages in the store. 

Now, with that image firmly in your head, keep in mind that bacteria are living things. They consume, metabolize and excrete, just like us. While that meat is waiting for you to purchase it and not think about where it came from, all the e. coli, salmonella, clostridium, staph, listeria and enterococcus is happily consuming the meat and excreting the bacteria version of poop into your lamb chop. Later, if the heat of the cooking process isn’t enough to kill all the bacteria and break down all the bacteria poop, it ends up in your tummy. Even if your body can handle the bacteria, it probably can’t handle the bacterial poop, which is made up of all kinds of fun toxins & chemicals. What doesn’t end up in your tummy winds up in tupperware containers so you can eat it later. The bacteria process starts all over again in the leftovers, so even if the first batch didn’t sicken you, the leftovers might, particularly since microwaves don’t heat evenly. So relatively vast colonies of bacteria and their poop can make it into your belly from the cooked leftovers too.

And for all you vegetarians out there, sitting at your laptop all smug and self-righteous, the same thing can happen with your bean sprouts and tofu. Who's picking and packaging your food? Probably not a bunch of other vegetarians. It's a bunch of undocumented workers trying to hustle a buck or euro by picking your lettuce, arugula, swiss chard and soybeans. They're out in the fields picking and packaging with some foreman yelling at them to hurry up before Immigration catches up with them. So when Juan or Abdullah or Cho needs to go to the bathroom, he'll be hitting the outhouse, or maybe he'll just go right there in the field. With no time or facilities to wash his hands, your broccoli arrives to you with a little staphylococcus souvenir.

How to prevent and treat food poisoning? First, proper handling and cooking is paramount. Unless you work in a slaughterhouse, that part is kind of out of your hands. Wash your food, because God only knows what illegal immigrants with questionable bathroom hygiene handled it between the farm and your table. Cook it thoroughly to kill bacteria and denature the poop chemicals. Store it refrigerated to retard bacterial growth, and reheat it thoroughly. Basically do everything they taught you in grammar school. One other thing - those heat lamps over prepared food or the tiny burners under the chafing dish at a buffet do NOT prevent bacterial growth. In fact, the slightly elevated temperature provides a bacterial paradise for the little guys to be fruitful and multiply. When treating food poisoning, diarrhea and vomiting can cause severe dehydration. If PO fluids can be tolerated, rehydrate that way. Most likely, IV fluids will be necessary. On the streets, there’s not much you can do for the electrolyte imbalances that occur, but expect an abnormal EKG from hypokalemia. Some patients may have burned up all their glycogen reserves since they can't eat without vomiting, and their cells try to consume glucose, so some may experience hypoglycemia. Urine output will be decreased, so be sure to ask your patient about that, as acute renal failure can occur. Be especially suspicious of dehydration in the elderly and the very young. Expect a few rounds of antibiotics to deal with the invading bacteria. 

So no, food poisoning is not fun, but it’s not an insidious crime and it probably should be renamed. It can happen to anyone, anywhere. And if someone in the house gets sick with food poisoning, throw out the offending culprit. Don’t do as I saw, when two people were obviously sick from bad crawfish. When I told them to throw it out, old Grandpa decided to start eating them right there in front of us. New crawfish is cheaper than a hospital visit and no, you won’t win your stupid lawsuit.

Onward and upward...